| Langlade Hospital - Hotel Dieu Of St Joseph Of Antigo Wisconsin | |
|
W10618 Clinic St Elcho WI 54428-9619 | |
| (715) 275-4011 | |
| Not Available |
| Full Name | Langlade Hospital - Hotel Dieu Of St Joseph Of Antigo Wisconsin |
|---|---|
| Speciality | Clinic/Center |
| Location | W10618 Clinic St, Elcho, Wisconsin |
| Authorized Official Name and Position | Jerry M Yang (SVP & CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 7158472526 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Langlade Hospital - Hotel Dieu Of St Joseph Of Antigo Wisconsin 29980 Network Pl Chicago IL 60673-1299 Ph: (715) 847-2304 | Langlade Hospital - Hotel Dieu Of St Joseph Of Antigo Wisconsin W10618 Clinic St Elcho WI 54428-9619 Ph: (715) 275-4011 |
| NPI Number | 1831251040 |
|---|---|
| Provider Enumeration Date | 12/14/2006 |
| Last Update Date | 06/13/2024 |
| Medicare PECOS PAC ID | 1557271202 |
|---|---|
| Medicare Enrollment ID | O20040212000310 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831251040 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Secondary |
| 261Q00000X | Clinic/center | (Wisconsin) | Secondary |
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
| Provider Name | Kshamata Shalini |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023099306 PECOS PAC ID: 0840196036 Enrollment ID: I20031209000630 |
| Provider Name | Stephen W. Hubbard |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1366434961 PECOS PAC ID: 6002705811 Enrollment ID: I20040311000344 |
| Provider Name | Joseph R. Lacy |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1598740599 PECOS PAC ID: 9335039130 Enrollment ID: I20040316001356 |
| Provider Name | Richard J Mayrer |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1023047859 PECOS PAC ID: 7810977717 Enrollment ID: I20040721001565 |
| Provider Name | Bonnie J Hessedal |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1023233822 PECOS PAC ID: 7416921929 Enrollment ID: I20040820001045 |
| Provider Name | Cary G Tauchman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1891800389 PECOS PAC ID: 7719954197 Enrollment ID: I20040915000028 |
| Provider Name | Ellyn M Meshel |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1205875242 PECOS PAC ID: 9335114024 Enrollment ID: I20041008000009 |
| Provider Name | David D Vanderkin |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1962407197 PECOS PAC ID: 3779486030 Enrollment ID: I20050106000937 |
| Provider Name | Renee M Smith |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750310900 PECOS PAC ID: 9537117296 Enrollment ID: I20050110000337 |
| Provider Name | Rebecca Reim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1043211766 PECOS PAC ID: 2668416744 Enrollment ID: I20050620000605 |
| Provider Name | Christopher Gary Peterson |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1700897535 PECOS PAC ID: 8820024474 Enrollment ID: I20050714000500 |
| Provider Name | Bart R Kneeland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1265466296 PECOS PAC ID: 5395773048 Enrollment ID: I20050803000064 |
| Provider Name | Kristine E Flowers |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1669405676 PECOS PAC ID: 9830127588 Enrollment ID: I20050803000077 |
| Provider Name | Jessica M Engel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1114037793 PECOS PAC ID: 6204868086 Enrollment ID: I20050831000858 |
| Provider Name | Robert A Selden |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1427086875 PECOS PAC ID: 5890747356 Enrollment ID: I20050916000474 |
| Provider Name | Kasra A Milani |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1124089750 PECOS PAC ID: 7911927306 Enrollment ID: I20051130000446 |
| Provider Name | Kristen Marie Wells |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1780642397 PECOS PAC ID: 0840212585 Enrollment ID: I20051222000310 |
| Provider Name | Noel N Deep |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1467470864 PECOS PAC ID: 7810904240 Enrollment ID: I20060309000621 |
| Provider Name | Carlos X Condado |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1205028768 PECOS PAC ID: 2860478690 Enrollment ID: I20060313000396 |
| Provider Name | Christian Degregorio |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1184676827 PECOS PAC ID: 4486665544 Enrollment ID: I20060606000075 |
| Provider Name | Nicole L Wade |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1497714406 PECOS PAC ID: 3173536703 Enrollment ID: I20060726000057 |
| Provider Name | Kathleen A Freeland |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710094123 PECOS PAC ID: 1850397118 Enrollment ID: I20061010000057 |
| Provider Name | Debra A Safford |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1063512382 PECOS PAC ID: 6002813698 Enrollment ID: I20061024000278 |
| Provider Name | Lakshmi Deep |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1336172303 PECOS PAC ID: 1456361963 Enrollment ID: I20070209000318 |
| Provider Name | Frank J Mchugh |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1134170228 PECOS PAC ID: 7315990330 Enrollment ID: I20070426000251 |
| Provider Name | Peter M Mccool |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1306044847 PECOS PAC ID: 3274620133 Enrollment ID: I20071025000076 |
| Provider Name | Diane L Reetz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1942497185 PECOS PAC ID: 4688762511 Enrollment ID: I20071110000133 |
| Provider Name | Michael A Umland |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1518920578 PECOS PAC ID: 2062593023 Enrollment ID: I20080115000827 |
| Provider Name | Mitchell L Lewis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912956137 PECOS PAC ID: 3870686462 Enrollment ID: I20080222000358 |
| Provider Name | Narasimha R Saladi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528257045 PECOS PAC ID: 6901796473 Enrollment ID: I20080306000611 |
| Provider Name | Corey L Slominski |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1841491875 PECOS PAC ID: 4587740444 Enrollment ID: I20080318000769 |
| Provider Name | Gregory G Dodge |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1497857171 PECOS PAC ID: 2062583883 Enrollment ID: I20080620000451 |
| Provider Name | Thomas W Tully |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1851369664 PECOS PAC ID: 6709847874 Enrollment ID: I20080919000462 |
| Provider Name | Susanne J Schaars |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1942381488 PECOS PAC ID: 5294802476 Enrollment ID: I20080930000648 |
| Provider Name | Kelly B Jankowsky |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952550576 PECOS PAC ID: 3173691102 Enrollment ID: I20081003000731 |
| Provider Name | Melissa L Ferg |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1982869434 PECOS PAC ID: 5193886471 Enrollment ID: I20081204000670 |
| Provider Name | Michael P Bellino |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1780670950 PECOS PAC ID: 1153224431 Enrollment ID: I20090602000566 |
| Provider Name | Christian Zuver |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194843367 PECOS PAC ID: 5890887830 Enrollment ID: I20090624000126 |
| Provider Name | Barbara L Rothweiler |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1376544247 PECOS PAC ID: 8426100256 Enrollment ID: I20090709000049 |
| Provider Name | Susan Frangiskakis |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1932172053 PECOS PAC ID: 9032123591 Enrollment ID: I20090722000611 |
| Provider Name | Jennifer A Mikulich |
|---|---|
| Provider Type | Practitioner - Registered Dietitian Or Nutrition Professional |
| Provider Identifiers | NPI Number: 1831128669 PECOS PAC ID: 2163575283 Enrollment ID: I20090806000244 |
| Provider Name | Dimitrios Mougolias |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1053520700 PECOS PAC ID: 3375632748 Enrollment ID: I20090824000666 |
| Provider Name | Emmanuel O Nwadike |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1962686485 PECOS PAC ID: 1456407618 Enrollment ID: I20090914000503 |
| Provider Name | Michael D Repplinger |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154521425 PECOS PAC ID: 5294872693 Enrollment ID: I20091016000136 |
| Provider Name | Michael D Polka |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1144242223 PECOS PAC ID: 3072654425 Enrollment ID: I20100106000782 |
| Provider Name | James E Svenson |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1700847183 PECOS PAC ID: 5698805455 Enrollment ID: I20100604001133 |
| Provider Name | Lonna L Grosskopf |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1003856618 PECOS PAC ID: 4284765116 Enrollment ID: I20100621000934 |
| Provider Name | Michael C Walters |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1063473973 PECOS PAC ID: 1456482017 Enrollment ID: I20100625000120 |
| Provider Name | Adetunji A Adejumo |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1942532528 PECOS PAC ID: 9638294986 Enrollment ID: I20100910000295 |
| Provider Name | Dennis Mcfadden |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1184758237 PECOS PAC ID: 2961580717 Enrollment ID: I20101004000991 |
| Provider Name | Shefiu O Shittu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1154646727 PECOS PAC ID: 5799977401 Enrollment ID: I20101012001243 |
| Provider Name | Jaren G Thomas |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1164645164 PECOS PAC ID: 2567654106 Enrollment ID: I20101014000263 |
| Provider Name | Okechukwu N Kanu |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1871817593 PECOS PAC ID: 1850584772 Enrollment ID: I20101022000966 |
| Provider Name | William Y Ansa Otu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1346564168 PECOS PAC ID: 2365635208 Enrollment ID: I20101022001131 |
| Provider Name | Anna Kathryn Olson |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1790992295 PECOS PAC ID: 7214122050 Enrollment ID: I20101105001271 |
| Provider Name | Larry R Brunzlick |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1770646721 PECOS PAC ID: 4385832344 Enrollment ID: I20101217000680 |
| Provider Name | Carl J Viviano |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1811925829 PECOS PAC ID: 0244142834 Enrollment ID: I20110114000960 |
| Provider Name | Joseph W Babiarz |
|---|---|
| Provider Type | Practitioner - Urology |
| Provider Identifiers | NPI Number: 1962446476 PECOS PAC ID: 4284823634 Enrollment ID: I20110114001090 |
| Provider Name | Navid A Majid |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1225327828 PECOS PAC ID: 9931386406 Enrollment ID: I20110609000346 |
| Provider Name | Patrick A Mckenna |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1831358142 PECOS PAC ID: 0941487359 Enrollment ID: I20110613000612 |
| Provider Name | Daniel S Skeen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487942694 PECOS PAC ID: 6608046404 Enrollment ID: I20110906000343 |
| Provider Name | Tanya B Lechtev |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1245498005 PECOS PAC ID: 2264563832 Enrollment ID: I20110912000158 |
| Provider Name | Steven P Phillipson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1023034105 PECOS PAC ID: 0345141313 Enrollment ID: I20110923000055 |
| Provider Name | Michael E Traktman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1356325740 PECOS PAC ID: 6406820513 Enrollment ID: I20111004000296 |
| Provider Name | Lance M Kelly |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1689959777 PECOS PAC ID: 0446426993 Enrollment ID: I20120104000476 |
| Provider Name | Andrew D Snider |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1659548584 PECOS PAC ID: 4284770439 Enrollment ID: I20120614000125 |
| Provider Name | Trina Daniels |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1578706073 PECOS PAC ID: 7618132804 Enrollment ID: I20120713000579 |
| Provider Name | Marc D Biedermann |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1912131699 PECOS PAC ID: 0547416547 Enrollment ID: I20120807000591 |
| Provider Name | Cody A Nikolai |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1295952539 PECOS PAC ID: 6901052695 Enrollment ID: I20120813000402 |
| Provider Name | Vimarsh Raina |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1508177841 PECOS PAC ID: 9537315064 Enrollment ID: I20120815000587 |
| Provider Name | Niaz M Haque |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871783407 PECOS PAC ID: 9234271107 Enrollment ID: I20120917000455 |
| Provider Name | Timothy E Wasano |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1982959391 PECOS PAC ID: 1658356175 Enrollment ID: I20121012000317 |
| Provider Name | Katie B Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568714723 PECOS PAC ID: 7315198603 Enrollment ID: I20121114000432 |
| Provider Name | Sarah J Staff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881944858 PECOS PAC ID: 0345492724 Enrollment ID: I20121228000191 |
| Provider Name | Kyle J Hunter |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154648020 PECOS PAC ID: 3274788583 Enrollment ID: I20130312000140 |
| Provider Name | Joseph Ponik |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1619214152 PECOS PAC ID: 5597900613 Enrollment ID: I20130320000618 |
| Provider Name | Coy H Johnston |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720371321 PECOS PAC ID: 9537112545 Enrollment ID: I20130321000458 |
| Provider Name | Maria Tillman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1992967673 PECOS PAC ID: 2961687827 Enrollment ID: I20130325000536 |
| Provider Name | Ashley E St Clair |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1598035768 PECOS PAC ID: 7911143110 Enrollment ID: I20130412000444 |
| Provider Name | Christopher S Platta |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1811127301 PECOS PAC ID: 6305083312 Enrollment ID: I20130511000060 |
| Provider Name | Olga Barchugova |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1750562617 PECOS PAC ID: 2567658388 Enrollment ID: I20130709000716 |
| Provider Name | Michael J Olson |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1891062592 PECOS PAC ID: 0941466585 Enrollment ID: I20130806000324 |
| Provider Name | Nicole M Wolfgram |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447593454 PECOS PAC ID: 9931333119 Enrollment ID: I20131001000043 |
| Provider Name | Liova E Rivera-garcia |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1790712610 PECOS PAC ID: 2062420318 Enrollment ID: I20131009000994 |
| Provider Name | Jiannan Zhang |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1366875338 PECOS PAC ID: 5294961330 Enrollment ID: I20131120001741 |
| Provider Name | Helen Blanch Cueny |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1720003999 PECOS PAC ID: 7618981838 Enrollment ID: I20131202001573 |
| Provider Name | Adam G Clements |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1033477997 PECOS PAC ID: 0749419778 Enrollment ID: I20140214000951 |
| Provider Name | Richard A Joseph |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1982818571 PECOS PAC ID: 7416850391 Enrollment ID: I20140325001938 |
| Provider Name | Matthew J Koeberl |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1396975165 PECOS PAC ID: 1254555774 Enrollment ID: I20140624000090 |
| Provider Name | Ridhwi Mukerji |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1366735755 PECOS PAC ID: 5698990364 Enrollment ID: I20140714001681 |
| Provider Name | Andrea Jolley-paulet |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1154301463 PECOS PAC ID: 2668377656 Enrollment ID: I20141110001776 |
| Provider Name | Jennifer J Lee |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831530583 PECOS PAC ID: 4688899552 Enrollment ID: I20150218000270 |
| Provider Name | Kris Ferguson |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1376751271 PECOS PAC ID: 1658422480 Enrollment ID: I20150226001814 |
| Provider Name | Jennifer Jean Delaney |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1992733166 PECOS PAC ID: 2365493061 Enrollment ID: I20150320001396 |
| Provider Name | Jennifer I Jordan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255739470 PECOS PAC ID: 1850618901 Enrollment ID: I20150330000620 |
| Provider Name | Nicole K Rice |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1831582436 PECOS PAC ID: 3476872896 Enrollment ID: I20150507000572 |
| Provider Name | Vicki L Maguire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215328794 PECOS PAC ID: 7315266467 Enrollment ID: I20150512001577 |
| Provider Name | Giovanni Salerno |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1942242698 PECOS PAC ID: 8325947237 Enrollment ID: I20150520000704 |
| Provider Name | Kyle Dembowiak |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1235499815 PECOS PAC ID: 7517271539 Enrollment ID: I20150805006698 |
| Provider Name | Jayanna Lynn Volm |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619358678 PECOS PAC ID: 8224344866 Enrollment ID: I20150827002457 |
| Provider Name | Jeffrey E Ilsley |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194703991 PECOS PAC ID: 8628037207 Enrollment ID: I20150914000152 |
| Provider Name | Herbert C Hoover |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1386683613 PECOS PAC ID: 0648262790 Enrollment ID: I20160203002363 |
| Provider Name | Daniel Eric Salinsky |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1649400227 PECOS PAC ID: 7911154745 Enrollment ID: I20160426000326 |
| Provider Name | Aaron M Wright |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568911097 PECOS PAC ID: 5799063343 Enrollment ID: I20161102000345 |
| Provider Name | Kara Hall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1225403769 PECOS PAC ID: 3870877210 Enrollment ID: I20170301002669 |
| Provider Name | David Bingham |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1831393628 PECOS PAC ID: 7911186549 Enrollment ID: I20170505000850 |
| Provider Name | Michael A Ward |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1316279433 PECOS PAC ID: 5294901526 Enrollment ID: I20170706000889 |
| Provider Name | Efe M Akpoigbe |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1023365152 PECOS PAC ID: 9032334891 Enrollment ID: I20170719003840 |
| Provider Name | Todd M Andres |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588846497 PECOS PAC ID: 7012282247 Enrollment ID: I20171013001117 |
| Provider Name | Jappan J Bhatt |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1669594115 PECOS PAC ID: 2567562952 Enrollment ID: I20171026001437 |
| Provider Name | Sara Starr |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1518471838 PECOS PAC ID: 2264790203 Enrollment ID: I20171220000408 |
| Provider Name | Daniel Eggeman |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1336568450 PECOS PAC ID: 5799085544 Enrollment ID: I20180411000255 |
| Provider Name | Benjamin J Graboyes |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720424807 PECOS PAC ID: 2264723519 Enrollment ID: I20180615000361 |
| Provider Name | Ahmed F Mohammed |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1407231178 PECOS PAC ID: 1557619913 Enrollment ID: I20180801004049 |
| Provider Name | Katie E Vangoethem |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760962393 PECOS PAC ID: 7012267958 Enrollment ID: I20180913002198 |
| Provider Name | Christina L Leslie |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1114328960 PECOS PAC ID: 3577817675 Enrollment ID: I20181108000071 |
| Provider Name | Brittany K Santiago |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1275000259 PECOS PAC ID: 3072859966 Enrollment ID: I20190115000057 |
| Provider Name | Richard Prokesch |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1427064583 PECOS PAC ID: 2668411570 Enrollment ID: I20190319000054 |
| Provider Name | Jennifer J Schmidt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184180994 PECOS PAC ID: 7517208879 Enrollment ID: I20190415001148 |
| Provider Name | Shirin Sultana |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053610691 PECOS PAC ID: 7416266846 Enrollment ID: I20190423001599 |
| Provider Name | Lance Matthew Orr |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1548230790 PECOS PAC ID: 7113919879 Enrollment ID: I20190502000904 |
| Provider Name | Sara A Pavelski |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1851738397 PECOS PAC ID: 6002159480 Enrollment ID: I20190529000633 |
| Provider Name | Cassie S Jentges |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1912564485 PECOS PAC ID: 3870827280 Enrollment ID: I20190618003219 |
| Provider Name | Jamie Lynn Schneider |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1801240858 PECOS PAC ID: 3072877364 Enrollment ID: I20190711002059 |
| Provider Name | Rachael E Miller |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1487218400 PECOS PAC ID: 1355677436 Enrollment ID: I20190726001817 |
| Provider Name | Roshini A Samuel |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1548612922 PECOS PAC ID: 8224365176 Enrollment ID: I20190815000037 |
| Provider Name | Shane D Franklin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1417301631 PECOS PAC ID: 2961730718 Enrollment ID: I20190819001394 |
| Provider Name | Kelly Jonathon Douck |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1447807086 PECOS PAC ID: 6305177429 Enrollment ID: I20191003002525 |
| Provider Name | Melissa M Jensen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295381481 PECOS PAC ID: 4789915752 Enrollment ID: I20191007001981 |
| Provider Name | Calla J Scheel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417599804 PECOS PAC ID: 5698107613 Enrollment ID: I20191113002019 |
| Provider Name | Nathan D Mcparlan |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1073656955 PECOS PAC ID: 3173680089 Enrollment ID: I20200207000002 |
| Provider Name | Andrew Huang |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1679957526 PECOS PAC ID: 7113256025 Enrollment ID: I20200610000620 |
| Provider Name | Thomas C Howard |
|---|---|
| Provider Type | Practitioner - Plastic And Reconstructive Surgery |
| Provider Identifiers | NPI Number: 1932369584 PECOS PAC ID: 0749583706 Enrollment ID: I20200610001054 |
| Provider Name | Justin Teresinski |
|---|---|
| Provider Type | Practitioner - Certified Registered Nurse Anesthetist (crna) |
| Provider Identifiers | NPI Number: 1134615131 PECOS PAC ID: 1153679048 Enrollment ID: I20200618000908 |
| Provider Name | Nicole M Held |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1477085652 PECOS PAC ID: 7214362185 Enrollment ID: I20200622001306 |
| Provider Name | Amy Jeanne Defranco |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962045393 PECOS PAC ID: 2466697842 Enrollment ID: I20200713000588 |
| Provider Name | Johonna Asquith |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1730447400 PECOS PAC ID: 5395986848 Enrollment ID: I20200720000195 |
| Provider Name | Colleen E Lane |
|---|---|
| Provider Type | Practitioner - Interventional Cardiology |
| Provider Identifiers | NPI Number: 1659717312 PECOS PAC ID: 3779722251 Enrollment ID: I20200814002130 |
| Provider Name | Syed M Imam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699202408 PECOS PAC ID: 8527339514 Enrollment ID: I20200917001379 |
| Provider Name | Susan Acuna |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1720030893 PECOS PAC ID: 8527056340 Enrollment ID: I20200922002401 |
| Provider Name | Justin Asquith |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1699031138 PECOS PAC ID: 1052603636 Enrollment ID: I20200925001250 |
| Provider Name | Jordan Knopf |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1588015465 PECOS PAC ID: 1759701402 Enrollment ID: I20201019000687 |
| Provider Name | Waleed Mansour |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1043628589 PECOS PAC ID: 1557661980 Enrollment ID: I20201210002640 |
| Provider Name | Patrick Odia |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1285041285 PECOS PAC ID: 0547530859 Enrollment ID: I20201216001494 |
| Provider Name | Evon Louise Schexnaydre |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1386603561 PECOS PAC ID: 8325052061 Enrollment ID: I20201222000551 |
| Provider Name | Nancy Rihana |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1982835237 PECOS PAC ID: 5294954699 Enrollment ID: I20210201000594 |
| Provider Name | John Pietila |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1841450772 PECOS PAC ID: 9133353014 Enrollment ID: I20210215000943 |
| Provider Name | Alaina Below |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750931481 PECOS PAC ID: 6406263060 Enrollment ID: I20210325002754 |
| Provider Name | Emily C. Merfeld |
|---|---|
| Provider Type | Practitioner - Radiation Oncology |
| Provider Identifiers | NPI Number: 1194222554 PECOS PAC ID: 4486901683 Enrollment ID: I20210407001145 |
| Provider Name | Erin Nelson |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1568046548 PECOS PAC ID: 8123427341 Enrollment ID: I20210520001211 |
| Provider Name | Srikar Karanam |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1588034227 PECOS PAC ID: 5092074302 Enrollment ID: I20210615003299 |
| Provider Name | Jalel Abera Hunde |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1194220558 PECOS PAC ID: 5597167569 Enrollment ID: I20210713003344 |
| Provider Name | Nathalie Jean |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1700134293 PECOS PAC ID: 2264663186 Enrollment ID: I20210714001952 |
| Provider Name | Angelica T Hon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144892464 PECOS PAC ID: 5799189742 Enrollment ID: I20210812001983 |
| Provider Name | Tom T Chen |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1922389048 PECOS PAC ID: 0941578736 Enrollment ID: I20210813001496 |
| Provider Name | Emmanuel Trigenis |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1225011844 PECOS PAC ID: 7719074319 Enrollment ID: I20210831002964 |
| Provider Name | Nathan J Walters |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1730281312 PECOS PAC ID: 1254366933 Enrollment ID: I20211007003223 |
| Provider Name | Maxwell Henricks |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1578927547 PECOS PAC ID: 0941547301 Enrollment ID: I20211109003207 |
| Provider Name | Danielle Espe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750985453 PECOS PAC ID: 3577975176 Enrollment ID: I20211130003075 |
| Provider Name | Angela Haroldson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1467121681 PECOS PAC ID: 1052701240 Enrollment ID: I20211202000156 |
| Provider Name | Anna-maria Cerilli |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1235710880 PECOS PAC ID: 1355734559 Enrollment ID: I20220211000407 |
| Provider Name | Sonny Yong Park |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1720071277 PECOS PAC ID: 2264443233 Enrollment ID: I20220621001207 |
| Provider Name | Idiris Abdirahman Esse |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1457813420 PECOS PAC ID: 8628458932 Enrollment ID: I20220705001239 |
| Provider Name | Casey Terrence Waldvogel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578202867 PECOS PAC ID: 8123400470 Enrollment ID: I20220802003910 |
| Provider Name | Ross Trecartin |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1205495694 PECOS PAC ID: 6507249125 Enrollment ID: I20220815003118 |
| Provider Name | Salman Mandhai |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1639445166 PECOS PAC ID: 4981914538 Enrollment ID: I20220826002130 |
| Provider Name | Andrew Wilke |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1427785872 PECOS PAC ID: 5395120976 Enrollment ID: I20220918000028 |
| Provider Name | Monica Cespedes Santana |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1114204161 PECOS PAC ID: 7214212653 Enrollment ID: I20221008000304 |
| Provider Name | Carole Vincent |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1497731038 PECOS PAC ID: 9830131994 Enrollment ID: I20221103000709 |
| Provider Name | Omar M El-sheikh |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1760681225 PECOS PAC ID: 6901030097 Enrollment ID: I20221104002088 |
| Provider Name | Jordan William Abel |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1417273301 PECOS PAC ID: 4789806522 Enrollment ID: I20221111000425 |
| Provider Name | Katie Seybold |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1629793948 PECOS PAC ID: 5698143345 Enrollment ID: I20221130001676 |
| Provider Name | David Slobodkin |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194795591 PECOS PAC ID: 3678545928 Enrollment ID: I20230104003063 |
| Provider Name | Jasdeep S Dalawari |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215986807 PECOS PAC ID: 1759275167 Enrollment ID: I20230206000761 |
| Provider Name | Manisha Shah |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1215012000 PECOS PAC ID: 7517120124 Enrollment ID: I20230208001789 |
| Provider Name | Ravindran Padmanabhan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1730114943 PECOS PAC ID: 5799727616 Enrollment ID: I20230302001458 |
| Provider Name | Andrea Caballero |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1003173824 PECOS PAC ID: 3274841770 Enrollment ID: I20230428001880 |
| Provider Name | Molly Marie Blemke |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1306546866 PECOS PAC ID: 0840656096 Enrollment ID: I20230515001609 |
| Provider Name | Elizabeth O Wendt |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1821784067 PECOS PAC ID: 3870959513 Enrollment ID: I20230522003253 |
| Provider Name | Patrick H Archie |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982895835 PECOS PAC ID: 0749355543 Enrollment ID: I20230602000332 |
| Provider Name | Tian Xia |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1437357423 PECOS PAC ID: 2961681713 Enrollment ID: I20230602002603 |
| Provider Name | Tiffany Justine Running |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861197667 PECOS PAC ID: 5395103238 Enrollment ID: I20230624000180 |
| Provider Name | Thomas Oliver |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1083069470 PECOS PAC ID: 9739477324 Enrollment ID: I20230711001880 |
| Provider Name | Richard Belt |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275064263 PECOS PAC ID: 1850643115 Enrollment ID: I20230731000081 |
| Provider Name | Carina Lea Hafner |
|---|---|
| Provider Type | Practitioner - Occupational Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1407284417 PECOS PAC ID: 8426411604 Enrollment ID: I20230906001205 |
| Provider Name | Tatyana Bombard |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1255629861 PECOS PAC ID: 0941595748 Enrollment ID: I20230911001645 |
| Provider Name | Amier Ahmad |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1689061897 PECOS PAC ID: 8224359807 Enrollment ID: I20230921000790 |
| Provider Name | Annika Grace Fox |
|---|---|
| Provider Type | Practitioner - Qualified Speech Language Pathologist |
| Provider Identifiers | NPI Number: 1033994702 PECOS PAC ID: 6204280324 Enrollment ID: I20230922003282 |
| Provider Name | Katy Lynn Anderson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295412815 PECOS PAC ID: 8527412295 Enrollment ID: I20230928002772 |
| Provider Name | Manavjot Singh Sidhu |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1356515845 PECOS PAC ID: 3274658083 Enrollment ID: I20231019001659 |
| Provider Name | Adrienne Anita Stevenson |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1497020697 PECOS PAC ID: 8426346958 Enrollment ID: I20240126002659 |
| Provider Name | Angela Joy Filbrandt-sheldon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1194591628 PECOS PAC ID: 0042663940 Enrollment ID: I20240126002940 |
| Provider Name | Shayla Hesse |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1689931305 PECOS PAC ID: 4082017868 Enrollment ID: I20240130001374 |
| Provider Name | Prunetta O Brunson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538662556 PECOS PAC ID: 8820353071 Enrollment ID: I20240314000164 |
| Provider Name | Michael Borgen |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1659039238 PECOS PAC ID: 8921487778 Enrollment ID: I20240315002759 |
| Provider Name | Angela L Arnold-ross |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1548713191 PECOS PAC ID: 0941588693 Enrollment ID: I20240321000816 |
| Provider Name | William Edwin Lavigne |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1083891311 PECOS PAC ID: 4385727643 Enrollment ID: I20240328000489 |
| Provider Name | Louis Joseph Mautone |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1144294513 PECOS PAC ID: 4082508577 Enrollment ID: I20240430002923 |
| Provider Name | Lauren Fiske |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1952509796 PECOS PAC ID: 8426270018 Enrollment ID: I20240605002258 |
| Provider Name | Michael Perez Rodriguez |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1376915330 PECOS PAC ID: 1850834318 Enrollment ID: I20240625002031 |
| Provider Name | Linda K Fox |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1386621837 PECOS PAC ID: 4587612684 Enrollment ID: I20240626001960 |
| Provider Name | Paul T Merchant |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1427554153 PECOS PAC ID: 3375890429 Enrollment ID: I20240701003894 |
| Provider Name | Diana M Wilmoth |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225609050 PECOS PAC ID: 1951846625 Enrollment ID: I20240717003724 |
| Provider Name | Kudirat Bukola Olatunde |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1649845074 PECOS PAC ID: 6406249218 Enrollment ID: I20240719000603 |
| Provider Name | Kr Spotts |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1083664486 PECOS PAC ID: 0840243440 Enrollment ID: I20240830003576 |
| Provider Name | Tiffany A Stoddard |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1720114846 PECOS PAC ID: 1557517893 Enrollment ID: I20240905001432 |
| Provider Name | Cody K Fox |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1285214445 PECOS PAC ID: 8123568045 Enrollment ID: I20240906000471 |
| Provider Name | Vincent Oyler |
|---|---|
| Provider Type | Practitioner - Emergency Medicine |
| Provider Identifiers | NPI Number: 1194174979 PECOS PAC ID: 4789976721 Enrollment ID: I20241005000012 |
| Provider Name | Danny Bourgeois |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1285824334 PECOS PAC ID: 5193965473 Enrollment ID: I20241210001329 |
| Provider Name | Jolita Auguste |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1063772283 PECOS PAC ID: 9739442484 Enrollment ID: I20250122001241 |
| Provider Name | Samuel Staehling |
|---|---|
| Provider Type | Practitioner - Hospitalist |
| Provider Identifiers | NPI Number: 1134824907 PECOS PAC ID: 7214467356 Enrollment ID: I20250205000990 |
| Provider Name | Enrico Braucher |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1407854409 PECOS PAC ID: 8224029384 Enrollment ID: I20250213000668 |
| Provider Name | Jessica Reynolds |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1205105731 PECOS PAC ID: 1557504594 Enrollment ID: I20250303001208 |
| Provider Name | Michael Slavin |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1194753806 PECOS PAC ID: 2163510389 Enrollment ID: I20250417002446 |
| Provider Name | Torbjorg A Holtestaul |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1295275428 PECOS PAC ID: 3274059878 Enrollment ID: I20250428000991 |
| Provider Name | Corina Belean |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134510332 PECOS PAC ID: 8628395647 Enrollment ID: I20250609002219 |